Efficacy of Motor Imagery in the Treatment of Poststroke Dysphagia: A Systematic Review and Meta-Analysis.

BACKGROUND

Poststroke dysphagia impairs patients' quality of life and survival. Motor imagery (MI) is increasingly used as a rehabilitation adjunct, but its efficacy requires validation. This study aims to evaluate MI's effectiveness in treating poststroke dysphagia.

METHODS

An extensive literature search was conducted across eight English and Chinese electronic databases (from inception to April 2025) to identify randomized controlled trials (RCTs) comparing the effects of MI combined with conventional therapy (experimental group) versus conventional therapy alone (control group) on poststroke dysphagia. The methodological rigor was assessed using the Cochrane Collaboration Risk of Bias Tool. Data analysis of the outcome measures was conducted using RevMan 5.3 software, with bootstrapped analysis to test the accuracy of primary outcomes.

RESULTS

Pooled analysis of 13 RCTs involving 1053 patients with poststroke dysphagia demonstrated that, compared to the control group, the MI supplementation group showed significantly lower water swallowing test scores (MD: -0.64, 95% CI: -0.76, -0.51, p < 0.00001) and standardized swallowing assessment scores (MD: -2.26, 95% CI: -2.94, -1.57, p < 0.00001) and higher swallowing quality of life scores (MD: 22.03, 95% CI: 7.25, 36.81, p = 0.003). Bootstrapping analysis substantiated the precision of these results. Furthermore, the meta-analysis revealed that add-on MI therapy significantly reduced the incidence of aspiration pneumonia (RR: 0.25, 95% CI: 0.12, 0.53, p = 0.0003) and increased clinical efficacy (RR: 1.23, 95% CI: 1.08, 1.39, p = 0.001). However, no significant effects were observed on aspiration incidence, malnutrition, or nasogastric tube removal rates.

CONCLUSION

Our findings support that MI therapy can be implemented as an add-on approach for poststroke dysphagia. More high-quality RCTs from multicenters are needed to provide more reliable evidence and explore the optimal treatment protocol.